Peer Services: Cost-Effective or Cheap Labor?

  • The Center for Medicaid Services in its 2007 letter indicated:


    "Peer support services are an evidence-based mental health model of care which consists of a qualified peer support provider who assists individuals with their recovery from mental illness and substance use disorders.  CMS recognizes that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a State's delivery of effective treatment."


    Research in the area of whether peer services are cost effective is broken down into three domains:


    The use of peer specialists instead of traditional day treatment.

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    In 2006, the Georgia Department of Behavioral Health & Developmental Disabilities compared consumers using certified peer specialists verses consumers who received the normal services in day treatment (the control group).


    The individuals using the peer specialists showed improvement in three outcomes as compared to the control group over an average of 260 days between assessments in all three areas:


    Reduction of current symptoms/behaviors, increase in skills/abilities, and ability to access resources/and meet their own needs.


    The use of the peer specialists cost Georgia on average $997 per year versus the average cost of $6,491 in day treatment, reducing the cost by $5,495 per person.


    Reduction in hospitalization.


    Using Peer Bridgers: the follow-up re-hospitalization rate was significantly less than the baseline hospitalization rate in one Peer Bridger Project.  During the 2-year baseline period: the matches were hospitalized an average of 60 percent of the time and while using the Bridgers they were re-hospitalized only 19 percent of the time.  A 41 percent improvement.  71 percent of the people the Peer Bridger worked with were able to stay out of the hospital in 2009.


    Pierce County Washington was able to reduce involuntary hospitalizations by 32 percent leading to a savings of 1.99 million dollars in one year by using peer specialists to offer respite services.


    Increase in adherence and other positive outcomes.


    Research shows using trained peers leads to improvement in psychiatric symptoms and decreased hospitalization.


    Consumers participating in peer programs had better adherence to medication regimens, had better healing outcomes, greater levels of empowerment, shorter hospital stays and less hospital admissions.


    This all sounds good yet I'm skeptical about the use of consumers for cheap labor.


    In New York City, peer advocates are paid minimum wage.  Most likely because they still want to collect a government disability check while working at a part-time job.  You can't pay rent and shop for groceries living on minimum wage so you're slated to live in supportive housing.


    Full-time peer advocate jobs here pay only $24K if you're lucky.  In the era of skyscraper NYC housing catering to the rich: $24K gets you subsistence living in an apartment the size of a closet.


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    I realize peer services are cost-effective yet it wouldn't break the bank either to pay peer specialists more money.  Our services would still be cost effective even if we were paid a livable salary.


    I also do not accept cheap labor as a substitute for credentials. 


    Peer specialists should be certified and fairly compensated.  Consumers should consider going for a Masters in Social Work (MSW) or at least a Bachelors in the field.


    Will peer services soon be covered by employer or other health insurance on par with professionals?  Do you think they should be?  I have mixed feelings about this.  I paid a cognitive therapist $100 per session.  I doubt a self-appointed peer guru could provide this service for $7.55/per hour.


    Possibly: a credentialed peer could provide this service.


    Yet I'm skeptical of consumers with an agenda who hang out a shingle preying on vulnerable individuals that have mental health challenges.


    Without credentialing, there's no guarantee you'll get best practices treatment.

    I'll end here with the request  for comments.


    Do you think peer specialists are the fix for a broken system?  Have you worked with a peer specialist and what was your experience with this person?  Are you a peer specialist yourself?


    All comments are welcome.

Published On: July 07, 2013